Form Remit STATE BANK OF INDIA CHICAGO IMPORTANT NOTICE 1. State Bank of India, chicago has stopped accepting through e-mail any request for initiating transactions or to update customer information. We recommend not sending any personal information to State Bank of India, Chicago by e-mail. 2. State Bank of India, Chicago has temporarily suspended issue of Rupee drafts and Remittance Official Checks in US Dollar. You may choose to remit funds by sending Rupee or US Dollar wire transfer. (US Dollar transfer will be sent to SBI Branches only) 3. As per latest CFPB guidelines on International funds transfer and requirements of DODD-FRANK ACT 2010, institutions including Banks doing international funds transfer has to give the “Prepayment Disclosure” to customer before effecting the remittances. For the remittance requests received by Fax or E-mail, we will be sending the pre-payment disclosure through E-mail. We request all the individual account holder of SBI Chicago to update their E-mail Id with us, if not provided at the time of account opening. For those individual account holders who do not have the valid E-Mail Id, the remittance request received by Fax or E-mail may be delayed and Bank shall not be responsible for any consequential loss. OUR CHARGES Effective from Dec 15, 2014 Rupee Remittances Fee – Wire Transfer For all amounts Consumer Accounts Accounts of Business & Associations $ 10* $ 25* Less than $ 10,000 Wire $ 45 Wire $ 45 $10,000 & above $ 50 $ 50 Wire Transfer in USD Dollar on SBI Branches in India Note: Consumer Accounts: Accounts of Natural persons *NEFT charges may be applied in India. Please refer to Reserve Bank of India website www.rbi.org.in for the exact NEFT charges In case of Dollar remittance, if the beneficiary’s account is in another branch in SBI which does not have a SWIFT facility, any charges deducted by the routing branch / receiving branch will have to be borne by the beneficiary. (See term D on Page 2 of the Application Form) STATE BANK OF INDIA, CHICAGO BRANCH APPLICATION FOR REMITTANCE TO INDIA 19 S LaSalle Street, Suite 200, Chicago, IL 60603 Ph: (312) 621-1200-(252/254) Fax 3127010232 I am an Account holder of your SBI Chicago Branch. I request you to remit funds on the terms and conditions governing such remittance detailed hereinafter (on page 1 & 2) and as per details given below: A REMITTER NAME * REGISTERED ADDRESS (with ZIP) *Registered Phone No: PURPOSE OF REMITTANCE B [ [ [ [ [ * Registered E-Mail: ] Family maintenance [ ] Personal expenses ] Savings or investment [ ] Gift ] Purchase of property [ ] Business Payment ] Charitable Donation(FCRA No): ] Others (specify) SOURCE OF FUNDS [ [ [ [ ] Current Income [ ] Past Savings ] Liquidation of Investment [ ] Loan/ LOC ] Sale of property [ ] Business Income ] Others (specify) BENEFICIARY (That is, the person or entity to whom you are sending money) NAME Relation ship [ ] Self/ Spouse [ ] Parent [ ] Children [ ] Uncle/ Aunt [ ] Sibling [ ] Nephew/Niece [ ] Business [ ] Other (specify) ADDRESS CITY PIN INDIA Beneficiary’s Bank Details (Draft can be issued on SBI Branches Only, mention only name and code of SBI branch on which the draft should be drawn) NAME OF THE BANK, ADDRESS & IFSC CODE A/C No (If not State Bank of India) State Bank of India Bank Name Branch Name Branch Code * (If State Bank of India) IFSC CODE * Route the remittance through the branch which has the following SWIFT Code SWIFT Branch: ISB Mumbai (1916) C MODE OF REMITTANCE TO INDIA INDIAN RUPEES WIRE US $ (To State Bank Branches Only) WIRE E Check any one box D SWIFT CODE: SBININBB136 DEBIT AUTHORIZATION DEBIT MY FOLLOWING ACCOUNT MAINTAINED WITH SBI CHICAGO ACCOUNT NO: PAYMENT AMOUNT ($) 777 F EXCHANGE RATE AMOUNT IN USD FOR OFFICE USE ONLY INR AMOUNT ADD: Our Charges** P&T RDD/ RTT/ DTT/ ROC -NO Date TOTAL I have read the terms and conditions governing this remittance and agree to be bound by them. Incase of remittance in US $ to India, I authorize its conversion into Indian rupees in India without reference to the beneficiary. I declare that this remittance complies with US and Indian laws. I also admit that I have read item D on Page 2. Value Date Remarks PREPARED BY Date: VERIFIED BY AUTHORIZED BY (SIGNATURE OF THE REMITTER) *Applications which do not contain complete information may be rejected or delayed, and Bank shall not be responsible for any consequential loss. 1. **For Rupee remittance and US Dollar remittance charges vary depending on the Customer type, amount and mode of remittance. 2. Remittance request made on a form other than prescribed form will not be accepted and such request will not be processed 3. Remittance request will be accepted by Fax or Postal Mail or In person at Bank's counters. 4. Remittance request sent by email will not be accepted and such request will not be processed. 5. Remittance request received by Fax or Postal mail will be processed only after Call and Confirmation by us through Registered Phone Number 6. Remittance Request will not be processed on the same Business day if the request is received by us after 1 P.M.(Central time) 7. Remittance Request will not be processed on the same Business day if the funds are not available by 1 P.M.(Central time) 8. Exchange rates prevailing on the day of processing will be applicable 9. Funds availability for personal check is 1 to 7 banking days after the day of deposit while for cashier’s check, it is one banking day. 10. Source or Proof of funds may be required and we may ask for documents evidencing Source or Proof of funds. Page 1 of 2 [Revd. December 2014] TERMS OF REMITTANCE FOR STATE BANK OF INDIA, CHICAGO A. Exchange rate of the day on which the transaction is executed is applied for all rupee remittances. B . Rupee Remittance to India can be sent by wire transfer to all branches of State Bank of India and NEFT-enabled branches of other banks. Dollar Remittances can be sent to SBI Branches only. In case of Dollar remittance, if the beneficiary’s account is in another branch of SBI which does not have SWIFT facility, dollar remittances will be routed through nearest SWIFT enabled branch and any charges deducted by the routing branch / receiving branch will have to be borne by the beneficiary. This may at times be a cause of delay and beyond the control of SBI Chicago branch. You may specify the branch through which the remittance is to be routed. SBI Chicago will not be responsible for any delays or deduction in charges. C. Applications which do not contain complete information may be rejected or delayed, and the Bank shall not be responsible for any consequential loss. Please mention the correct name and code of the SBI branch to which the remittance is to be sent. Remittances sent by wire will be credited to beneficiary’s account in India solely on the basis of the account number provided. Bank will not be held liable for any loss/delay resulting from incorrect or incomplete information provided by the remitter including account number. D. We would request you to confirm with the beneficiary within a reasonable time after sending remittance through us and bring to our notice non-delivery as soon as possible, but within 180 days of the date of the remittance. We will take up any case of nondelivery as expeditiously as possible. If you do not advise us non-delivery within 180 days, it may not be possible for us to trace the remittance thereafter. Any investigation carried out after 180 days will be charged. In case of false complaints about non delivery of funds to the designated branch, the remitter will have to bear the cost of investigation with minimum charges being $25. E. Cancellation or Retransmission or Amendment or to a remittance, after it has been processed will be charged $25 (each instance). (For sending remittances to charitable organizations, FCRA number must be mentioned in the application. In the absence of FCRA number, applicant can request for a draft to be issued.) CONDITIONS GOVERNING ISSUANCE OF REMITTANCE OFFICIAL CHECKS/DRAFTS In case this remittance is not paid, the drawer's liability will be conditioned upon surrender of duly endorsed original and duplicates and limited to refunding to the holder the equivalent of the face amount by (a) payment in United States dollars at the drawer's buying rate in Chicago, at the time of such surrender and refund, for the foreign money in which drawn, or at the drawer's option by (b) forwarding, by mail or otherwise, to the drawee or other banking house abroad with which it may then have or establish a sufficient credit in such foreign money instructions to withhold there from an amount equivalent to the face hereof for the account and risk of the holder hereof, and the drawer shall not be otherwise liable hereon or for the considerations received herefor. Reference to the foreign money in which this check is drawn shall mean such foreign money, or other foreign money into which it may then be convertible, impressed with restrictions and other characteristics which shall or would have attached to an unearmarked credit balance of the drawer's remaining with the drawee or such other banking house from the date hereof to the time of settlement. Such refund shall be reduced by any loss resulting from failure immediately to forward and promptly present this check (whether or not presentment would otherwise be dispensed with or delay excused) and refund may be withheld pending determination of such loss. Under no circumstances shall the Bank be liable for any consequential damages of any sort. CONDITIONS GOVERNING ISSUANCE OF WIRE TRANSFER This Bank agrees to send at the expense and risk of the customer a message directing payment in foreign funds in the amount and manner indicated. The Bank does not warrant that the transfer of funds will reach the payee. It may make use of any branch, or correspondent, agent or sub-agent and shall not be under any liability for any errors, negligence, suspension or default of any of them or for any failure to identify the payee or any mispayment by any of them nor shall the Bank be under any liability for any errors, mutilations, delays, mis-delivery or failure of delivery in the transmission of any message in connection with this transaction whether or not in code or whether by mail, postal service, telegraph, cable, wireless radio or otherwise, or for any suspension of any such means of transmission or for any imposition of any censorship, exchange control or other restriction, all such risks being borne by the customer. Under no circumstances shall the Bank be liable for any consequential damages of any sort. In case of transfer of currency other than the currency of the country to which remittance is made, it shall be payable to the payee in currency of said country at the buying rate of Bank's branch, or correspondent for exchange of the currency remitted unless the payee arranges with said correspondent for payment in some other form upon paying all charges in connection therewith. In case the funds are not paid to the payee, whatever the reason, any liability of the Bank will be conditioned upon its receipt from the branch or correspondent of confirmation of effective cancellation of the remittance abroad and shall be limited to refunding the amount to be remitted, less expenses, which refund, in the case of transactions relating to the remission of foreign money, shall be made by (a) payment in United States dollars at the Bank's buying rate in New York, at the time of such refund, for the foreign money to be remitted, or at the bank's option by (b) forwarding by mail or otherwise to the Bank's branch or correspondent or other banking houses abroad with which it may then have or establish a sufficient credit in such foreign money instructions to withhold therefrom an amount equivalent to the amount to be remitted for the account and risk of the person to whom refund is to be made, and the Bank shall not be otherwise liable in connection herewith or for the consideration received by it. References to the foreign money to be remitted shall mean such foreign money or other foreign money into which it may then be convertible, impressed with restrictions, and other characteristics which shall or would have attached to an unearmarked credit balance of the Bank remaining with its correspondent or such other banking house from the date hereof to the time of settlement. Anything hereinbefore to the contrary notwithstanding, any refund shall be made in case of mispayment of funds by any correspondent, agent or sub-agent, and in case funds for the payment of this transfer have been remitted or made available abroad or otherwise covered, no refund shall be made until the relative funds have been returned or otherwise made freely available to the Bank. IMPORTANT US tax law requires income from all sources, including that earned from foreign accounts, to be reported in the annual tax return. US Treasury Department rules require certain accounts at foreign financial institutions which are controlled by US Taxpayers to be reported annually. Advice should be obtained from your professional advisor for further clarification. Terms that are not identified in this agreement shall have the same meaning as defined in the Uniform Commercial Code, Article 4A. It is also subject to all applicable operating circulars of the Federal Reserve Bank of Chicago and any other applicable provision of federal or state law. To the extent that Regulation J does not apply, this agreement is governed by Illinois law. Page 2 of 2 [Revd.December 2014]